While it's true that people are still getting sick with H1N1 flu, and that we could be in for a 3rd wave of illness in this pandemic, convincing people to get vaccinated is a very tough sell these days. Clinics are still being scheduled and public health is doing its best to convince people it still not too late to get vaccinated, but it's likely that vaccine supply will continue to exceed demand. A situation not unlike most other flu seasons.
The New York Times reported last week that the U.S. has received more than 60 million doses of H1N1 vaccine from manufacturers so far. However, the federal government has contracts in place to receive more than 250 million doses. And, those contracts will not be canceled. The Times reported that federal health officials decided to go forward with the purchases as a hedge against a potential 3rd wave of illness which would spark a greater demand for vaccine by the public.
Efforts to get some of the excess vaccine to poor nations still in the flu's grip have been frustrated by logistical and structural problems.
As with every pandemic there will be many "lessons learned" from this current one. However, it is clear, as I wrote last October, that the greatest limiting factor to the response has been our inability to produce a vaccine fast enough to be ready when we needed it, and when the public wanted it. That's not to say that we haven't made significant progress over the years, but we need to do better in order to be prepared for the next flu pandemic.
As talk of freezing non-defense spending and a return to Pay-As-You-Go budgeting grows in Washington, will we make investment in flu vaccine research and technology a priority?
I think it's an open question.
The Boston Globe reports today that the Archdiocese of Boston is resuming key parts of its liturgy -- namely the sign of peace, and sharing of a common chalice -- that had been suspended during the second wave of the H1N1 flu pandemic here in Massachusetts. This will be a welcome return to the familiar for many Catholics.
It's been awkward giving the "nod of peace" these past several months. Of course, there were always folks who continued to offer their hand at the appropriate time, and it made you wonder; are they doing this out of protest, or haven't they been to church in a while?
The bigger question at this point is; are we out of the woods completely with H1N1, or will we see another wave? As you can see from the graphic below from MDPH, we often see a spike in cases in February with seasonal influenza. It's anyone's guess as to whether H1N1 will act the same way.
There probably has not been a better time to get vaccinated against 2009 H1N1 flu than right now. That's because many of the earlier restrictions on who could get vaccinated have been lifted. There is a greater supply of vaccine available, and there is still months of flu season ahead of us. Even though flu activity has dropped off significantly here in Massachusetts and elsewhere, it's important to remember that this pandemic strain of flu comes in waves. We could still get a third wave of flu later this winter or during the spring. 2009 H1N1 flu starting circulating widely in the U.S. in April of 2009.
A picture is worth a thousand words. This week's report from MDPH is encouraging, showing a continued drop in doctor visits for flu-like illnesses. Just a couple of weeks ago, nearly 10 percent of visits to the doctor were for the flu and now it's about 3.5 percent. Sadly, the report notes that two more people have died, including another young child from Middlesex County.
The question now is what will the flu season look like in the coming weeks and months. Will illnesses continue to drop? Will we level off and have another surge during the normal peak of flu season in January and February? Will the seasonal variety of flu reemerge as H1N1 recedes? Will we have another wave of H1N1 in the Spring?
The graph below shows an impressive level of flu activity over the last few weeks -- especially when measured against seasonal peaks from previous years. In future years this graph will help tell the story of this pandemic year. Here's the weekly report from DPH: Download Weekly-report-12_03_09
We interupt this flu blog for something related, but different. This is a video that I recently shot for the Public Health Museum, located in Tewksbury, MA. It's an interesting little museum for you history buffs looking for something unique. If you've got 5 mins. give the video a look.
The CDC made news today by releasing new figures that show flu-like illness decreasing in many states. Here in Massachusetts flu cases also appears to be coming down, but our state is still in the "widespread" flu category. As I mentioned in my previous post, there is usually a rhythm to flu outbreaks, with a rise in cases first, then hospitalizations and then deaths. That appears to be the case here. The Massachusetts Department of Public Health released its weekly report this past Friday and it showed that the number of deaths jumped by five (5) from the previous week.
That is likely one of the highest weekly weekly death totals since H1N1 flu first appeared in Massachusetts last April. That's worth noting, and worth emphasizing as more vaccine arrives in the state and people wonder whether or not they should bother getting vaccinated. They should.
There's some evidence nationally and here in Massachusetts that the current wave of H1N1 flu activity may have peaked. The weekly report from the Mass. Department of Public Health shows a decline in influenza-like illness from the previous week. You can download the State's report here: (Download Weekly-report-11_19_09) And today the CDC reported that all ten HHS regions of the U.S. are reporting a decline in flu-like illness. However, as we've seen throughout this pandemic, flu is unpredictable and can spread differently from community to community.
While many states are experiencing declines, states like Maine and Hawaii are experiencing increases. During the spring outbreak, here in Massachusetts, the city of Boston and Middlesex County were hit especially hard relative to other areas of the state.
The Mass. DPH also reported two additional deaths attributed to H1N1 today -- an adult and a child. These deaths are tragic reminders of how serious flu can be for some people. Unfortunately, we should prepare to hear about more deaths both nationally and here in the Bay State. There is often a rhythm to flu outbreaks; first come the increase in cases, then come the increase in hospitalizations and then come the reports of deaths. These deaths, especially in children, understandably increase anxiety but it is important to remember that most people who get the 2009 H1N1 flu will recover.
Here's a report on the most recent deaths from NECN featuring Dr. Lauren Smith, DPH Medical Director: